Maternal and Child Health Library
This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html.
June 15, 2007
1. Report Profiles Exemplary Adolescent Health Programs
2. Brief Highlights Community Efforts to Provide
Continuity of Mental Health Care and Developmentally Appropriate
Supports to Adolescents and Young Adults
3. Study Identifies Options for Improving Diet Quality
Among Food and Nutrition Program Participants
4. Authors Examine Loss Among Pregnancies Conceived
Through Assisted Reproductive Technology
5. Article Assesses Whether Home Visiting Is Associated
with Decreased Infant Death
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1. REPORT PROFILES EXEMPLARY ADOLESCENT HEALTH PROGRAMS
Under One Roof: Primary Care Models That Work for Adolescents profiles
three adolescent health programs in different settings that offer
comprehensive, interdisciplinary models of physical, behavioral, and
reproductive health care that are explicitly designed to welcome
adolescents and respond to their particular needs. The report,
published by Incenter Strategies, focuses on exemplary programs that
tailor their services to adolescents' unique needs through
multidisciplinary staffing, team-based approaches, staff sensitivity,
adolescent-friendly environments, and a focus on positive youth
development. The programs highlighted in the report include Mount Sinai
Adolescent Health Center in New York City (a hospital-based model);
Wake Teen Medical Services in Raleigh, North Carolina (an office-based
model); and Erie Teen Health Center in Chicago, Illinois (a community
health center model). The authors of the report discuss the
collaborative model of adolescent health care and the need for a new
model of care, present data on program effectiveness, and identify
financing challenges of various adolescent-health-care arrangements.
The report is intended for use by health professionals, policymakers,
program administrators, and others in considering new approaches to
better serve the needs of adolescents. The report is available at
http://www.incenterstrategies.org/jan07/Report1.pdf.
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2. BRIEF HIGHLIGHTS COMMUNITY EFFORTS TO PROVIDE CONTINUITY OF MENTAL
HEALTH CARE AND DEVELOPMENTALLY APPROPRIATE SUPPORTS TO ADOLESCENTS AND
YOUNG ADULTS
On the MOVE: Helping Young Adults with Serious Mental Health Needs
Transition into Adulthood presents findings and future directions from
an initiative to develop and implement transition programs for
adolescents with mental and emotional difficulties as they enter
adulthood. The brief, produced by the Substance Abuse and Mental Health
Services Administration's Partnership for Youth Transition (PYT)
Initiative, provides a snapshot of five PYT-funded sites in Maine,
Minnesota, Pennsylvania, Utah, and Washington. Topics include the
unique challenges of moving from adolescence to adulthood for
adolescents and young adults diagnosed with a serious emotional
disturbance or serious mental illness, matching services to the needs
of adolescents and young adults, and the Transition to Independence
Process Model. Data and preliminary findings from cross-sectional
analyses of the PYT projects are presented. Federal and state policy
recommendations and lists of resources and contacts are also included.
The report is available at
http://rs6.net/tn.jsp?t=haonyacab.0.gd6gzacab.4aek4xbab.16723&ts=S0253&p=http%3A%2F%2Fwww.connectforkids.org%2FPYT_brief.pdf.
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3. STUDY IDENTIFIES OPTIONS FOR IMPROVING DIET QUALITY AMONG FOOD AND
NUTRITION PROGRAM PARTICIPANTS
Could Behavioral Economics Help Improve Diet Quality For Nutrition
Assistance Program Participants? incorporates findings from behavioral
economics, food marketing, and psychology into a framework that can be
used to explore new methods of improving individuals' diets and health.
The report, published by the U.S. Department of Agriculture's Economic
Research Service, is based on a study that focused on four of the
largest assistance programs: the Food Stamp Program; the Special
Supplemental Nutrition Program for Women, Infants, and Children (WIC);
and the National School Lunch and Breakfast Programs (school meal
programs). Selected topics include standard policy levers that
influence food choices and how simple rules of thumb may influence what
individuals choose to eat, how much they eat, and how they evaluate
these decisions after the fact. A summary, conclusions, and references
are provided. The report is intended for use by health professionals,
educators, policymakers, researchers, and others in expanding
considerations for food policy, nutrition education, and social
marketing. The report is available at http://www.ers.usda.gov/publications/err43/err43.pdf.
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4. AUTHORS EXAMINE LOSS AMONG PREGNANCIES CONCEIVED THROUGH ASSISTED
REPRODUCTIVE TECHNOLOGY
"These findings suggest that the age of the oocyte plays a large role
in determining pregnancy success in early pregnancy," state the authors
of an article from the June 15, 2007, issue of the American Journal of
Epidemiology. Whether pregnancies conceived through assistive
reproductive technology (ART) are at increased risk of loss compared
with naturally conceived pregnancies is not clear. Examining the
associations among maternal age, type of ART procedure, and pregnancy
loss at different gestational ages is important in understanding the
etiology of pregnancy loss and in counseling pregnant women about their
risk of such loss. The article reports the estimated risk of pregnancy
loss at different gestational ages for ART pregnancies, by ART
procedure and maternal age. The authors also discuss the findings'
relevance to ART and naturally conceived pregnancies.
Data for the study were drawn from the Centers for Disease Control and
Prevention's ART surveillance system. ART was defined as "any procedure
that requires both oocytes and sperm be handled outside of the body."
Data included demographics and reproductive history; type of ART
procedure; and, if a pregnancy resulted, the maximum number of fetal
heartbeats in early pregnancy, the pregnancy outcome (live birth,
spontaneous or therapeutic abortion, stillbirth, maternal death,
unknown outcome), and the date of outcome. The final data set for the
analysis included 148,494 ART pregnancies. Pregnancies were subdivided
into 14 analytical groups on the basis of three criteria: (1) whether
patient or donor oocytes were used; (2) whether embryos were freshly
fertilized or frozen and thawed at the time of transfer; and (3) for
women who used their own oocytes, the woman's age at the time of the
ART procedure. The probability of pregnancy loss at specific
gestational weeks was estimated for each analytical group. Pregnancy
loss was defined as "loss of the entire pregnancy by either spontaneous
abortion or stillbirth." For relative risk estimates, overall survival
estimated for each of 13 ART procedure groups was compared with the
referent (pregnancies among women ages 32 and younger who used their
own oocytes and freshly fertilized embryos).
The authors found that
- The total risk of pregnancy loss for all pregnancies was 29%.
- The total risk of pregnancy loss ranged from 22% among
pregnancies to women ages 32 and younger using their own oocytes and
freshly fertilized embryos to 63% among pregnancies to women ages 43
and older using their own oocytes and freshly fertilized embryos.
- Conditional risk of pregnancy loss decreased rapidly during the
first trimester, from a high of 45% at 6 weeks among women ages 43 and
older using fresh embryos to between 2% and 7% for all groups at 12
weeks. By 20 weeks' gestation, the risk of subsequent loss was below 2%
for all groups.
- The conditional risk of pregnancy loss at 6 weeks' gestation
among women ages 32 and younger using their own oocytes and freshly
fertilized embryos was 10%.
The authors conclude that the results may (1) inform clinicians on
evaluating a patient's risk of pregnancy loss based on the patient's
age, ART procedure, pregnancy plurality, and gestational age of the
fetus; (2) inform reproductive health epidemiologists on population
risks of pregnancy loss and contribute to future research on its
etiology; and (3) provide information for naturally conceived
pregnancies among similar populations of women.
Farr SL, Schieve LA, Jamieson DJ. 2007. Pregnancy loss among
pregnancies conceived through Assisted Reproductive Technology, United
States, 1999-2002. American Journal of Epidemiology 165(12):1380-1388.
Abstract available at http://aje.oxfordjournals.org/cgi/content/abstract/165/12/1380.
Readers: More information is available from the report titled Assisted
Reproductive Technology Surveillance -- United States, 2004, published
in the June 8, 2007, issue of MMWR Surveillance Summaries. The report
is available at http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5606a1.htm.
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5. ARTICLE ASSESSES WHETHER HOME VISITING IS ASSOCIATED WITH DECREASED
INFANT DEATH
"Infant death may be considered the 'tip of the iceberg' in which
children of families at risk experience suboptimal care, poor health
outcomes, and the possibility of lifelong disability; some die before
their first birthday," write the authors of an article published in the
June 2007 issue of Pediatrics. The American Academy of Pediatrics
encourages pediatricians to support referral of high-risk parents to
home visitation programs as early as possible. Earlier trials have
found that home visiting by nurses reduced smoking during pregnancy,
decreased preterm birthrates for smokers, increased birthweights among
adolescent mothers, and decreased rates of child abuse and accidental
injuries in children. Studying the effects of home visitation on infant
mortality rates requires a larger sample size, which may be available
only in larger programs implemented in community settings. The purpose
of the study described in this article was to examine the impact of a
large-scale, community-based, home-visitation program. The authors
tested the hypothesis that participation in greater Cincinnati's Every
Child Succeeds (ECS) program is associated with a decreased risk of
infant death. ECS targets high-risk women having their first child,
that is, women who are adolescents, who are unmarried, with low
incomes, or who have suboptimal education.
A retrospective, case-controlled design was used to examine the impact
of home visiting on the likelihood of death before age 1 among infants
enrolled in the ECS program. ECS records were linked to Ohio and
Kentucky birth certificates. ECS program and control subjects were
matched for gestational age at birth, previous pregnancy loss, marital
status, and maternal age. Adjusted comparisons of the likelihood of
death before age 1 between ECS participants and control subjects were
made using multivariate logistic regression.
The authors found that
- After controlling for race, prenatal care, maternal smoking,
maternal education, and maternal age, enrollment in ECS was associated
with a 60% decrease in the likelihood of infant death.
- The differences between black participants in ECS and black
nonparticipants tended to be much larger than the differences observed
for nonblack infants.
- Among all the independent variables identified, adequacy of
prenatal care had the strongest association with the likelihood of
infant death.
- Black mothers enrolled in ECS before birth were more likely to
received adequate prenatal care, compared with control subjects.
- The largest association between ECS participation and reduced
infant mortality rate was seen for black infants.
- No influence of ECS enrollment on gestational age at birth was
observed.
The authors conclude that "our study findings are consistent with the
findings from randomized, controlled trials and suggest that home
visiting reduces the risk of infant death."
Donovan EF, Ammerman RT, Besl J, et al. 2007. Intensive home visiting
is associated with decreased risk of infant death. Pediatrics 119
(6):1145-1151. Abstract available at http://pediatrics.aappublications.org/cgi/content/abstract/119/6/1145.
Readers: More information is available from the MCH Library's knowledge
path, Infant Mortality, at http://www.mchlibrary.info/KnowledgePaths/kp_infmort.html;
from the bibliographies, Home Visiting and Resource Mothers, at http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_homevisit.html&-MaxRecords=all&-DoScript=auto_search_homevisit&-search
and Infant Mortality, at http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_infmortality.html&-MaxRecords=all&-DoScript=auto_search_infmortality&-search;
and from the organizations resource list, Infant Mortality Prevention,
at http://www.mchlibrary.info/action.lasso?-database=Organizations&-layout=Web&-response=/databases/OrgLists/orgs_infmort.html&-MaxRecords=all&-DoScript=auto_search_infmort&-search.
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MCH Alert © 1998-2007 by National Center for Education in Maternal
and
Child Health and Georgetown University. MCH Alert is produced by
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